Provider Demographics
NPI:1538515119
Name:SAMANIEGO, CZARINA SARAH
Entity Type:Individual
Prefix:MS
First Name:CZARINA SARAH
Middle Name:
Last Name:SAMANIEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 SIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3546
Mailing Address - Country:US
Mailing Address - Phone:732-614-7761
Mailing Address - Fax:
Practice Address - Street 1:14435 SIMMONS LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3546
Practice Address - Country:US
Practice Address - Phone:732-614-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS03361476456931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst